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First dorsal metacarpal artery perforator-based propeller flap: functional anatomy and clinical application in soft-tissue defects of the dorsal hand and digits

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Background

Many approaches have been reported to repair soft-tissue defects of the hand using dorsal metacarpal artery flaps. Use of a perforator-based propeller flap from the first intermetacarpal space to the dorsum of the hand has been described. The aim of this study was to confirm the functional anatomy of a first dorsal metacarpal artery (FDMA) perforator flap.

Methods

Twenty-nine fixed cadaveric hands were dissected to determine the origin, course, and branches of the FDMA. Clinically, five cases of soft tissue defects of the hand underwent reconstructive surgery using an FDMA perforator-based propeller flap.

Results

The FDMA was found in 27 specimens (93%). The ulnar branch of the FDMA always supplied the cutaneous perforator (mean ± SD, 4.3 ± 1.6), and the most distal cutaneous perforating branch was found along the metacarpal long axis within 25 mm of the tip of the metacarpal head with high frequency (28/29, 97%). In the two hands that had aplasia of the FDMA, well-developed perforators arose directly from the radial artery and advanced to the metacarpal head. Seven hands (24%) had perforators arising from the palmar arterial system, penetrating through or passing close by the second metacarpal bone. In clinical application, all the flaps survived completely without major complications.

Conclusions

The FDMA perforator-based propeller flap is minimally invasive and technically simple. It is expected to be a new option for hand reconstruction.

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Acknowledgements

We thank Mr. Hiroshi Sasaki at the Department of Anatomy and Neurobiology, National Defense Medical College for preparation of the cadavers and technical assistance.

Funding

No funding was received for this article.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Tetsushi Aizawa, Takahiro Hirayama & Tomoharu Kiyosawa

  2. Department of Anatomy and Neurobiology, National Defense Medical College, Saitama, Japan

    Yasushi Kobayashi

Authors
  1. Tetsushi Aizawa
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  2. Takahiro Hirayama
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  3. Tomoharu Kiyosawa
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  4. Yasushi Kobayashi
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Contributions

TA: Project development, Data collection, Data analysis, Manuscript writing. TH: Data collection. TK: Project development, Manuscript editing. YK: Technical advice, Manuscript editing.

Corresponding author

Correspondence to Tetsushi Aizawa.

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Conflict of interest

The authors declare that they have no conflict of interests.

Ethics approval

This study was performed in a university with institutional review board approval (No. 4151 and 4307).

Consent to participate/for publication

Written consents were obtained from the donors in advance, and the agreements to the donation and its use were obtained also from the families at donation. For the clinical application, patients give written informed consent according to the principles of the Declaration of Helsinki.

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Supplementary Information

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Supplementary file1 Online Resource 1 Dynamic fluorescence angiography of the left hand. Indocyanine green solution is injected into the radial artery. Locations and territories of the perforators can be detected in real time by using infrared CCD camera (Photodynamic Eye, Hamamatsu Photonics K.K., Shizuoka, Japan) (MP4 18919 KB)

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Aizawa, T., Hirayama, T., Kiyosawa, T. et al. First dorsal metacarpal artery perforator-based propeller flap: functional anatomy and clinical application in soft-tissue defects of the dorsal hand and digits. Surg Radiol Anat 44, 215–221 (2022). https://doi.org/10.1007/s00276-021-02845-z

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  • DOI: https://doi.org/10.1007/s00276-021-02845-z

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